Features suggesting portopulmonary hypertension in patients with cirrhosis
| History |
| Dyspnea, fatigue, chest pain |
| Syncope, presyncope |
| Weight gain |
| Lower-extremity swelling |
| Ascites |
| Clinical evidence of portal hypertension, eg, variceal hemorrhage, portal gastropathy, hepatic hydrothorax, ascites |
| Physical examination |
| Jugular vein distention |
| Wide, split second heart sound, with loud pulmonic component |
| Tricuspid regurgitation murmur |
| Parasternal heave |
| Hepatomegaly, pedal edema, ascites |
| Signs of cirrhosis: spider angiomata, jaundice, gynecomastia, caput medusa, palmar erythema, ascites, hepatosplenomegaly |
| Imaging and electrocardiography |
| Computed tomography: main pulmonary artery-to-ascending-aorta ratio ≥ 1, dilation of right atrium and ventricle |
| Electrocardiography: signs of right ventricular strain, right axis deviation, right atrial abnormality (P pulmonale), incomplete or complete right bundle branch block |
| Hepatic vein catheterization diagnostic of portal hypertension: hepatic venous pressure gradient ≥ 6 mm Hg |
| Echocardiography |
| Enlarged right atrial area (> 18 cm2) |
| Reduced right ventricular fractional area change (< 35%) |
| Flattened interventricular septum |
| D-shaped left ventricle |
| Right ventricular/left ventricular basal diameter > 1 |
| Peak tricuspid regurgitation jet velocity > 2.8 m/s |
| Right ventricular systolic pressure ≥ 45 mm Hg |
| Decreased tricuspid annular plane systolic ejection (< 18 mm) |
| Pulmonic insufficiency |
| Pulmonary artery diameter ≥ 25 mm |
| Inferior vena cava diameter > 21 mm with decreased respirophasic variation |